DESCRIPTION (provided by investigator): The objective of the proposed study is to determine care provider barriers that lead to disparities in provision of Kangaroo Mother Care (KMC) among non-white pre-term infants (PT) and to identify if KMC facilitates maternal to infant transmission of indigenous bacteria as a biological mechanism of its observed benefits. KMC is a method, endorsed by the World Health Organization, where the mother holds her naked PT skin-to-skin upright between the breasts to improve PT outcomes. We hypothesize that Neonatal Intensive Care (NICU) disparities exist where provider perception of benefit leads to unequal use of KMC for mothers who are non-white. We further hypothesize that KMC facilitates greater transmission and similarity of oral and skin bacteria profiles between KMC mother-infant pairs. Unlike healthy infants, the PT infant's underdeveloped immune system is unable to resist opportune growth of microorganisms in their bodies leading to risk for development of systemic illness and associated increased morbidity and mortality. Introduced in 1978 in Bogota, Columbia, KMC use has been associated with improved PT outcomes that coincide with improved long term immune function such as decreased diarrheal disease, infections, and increased infant survival in developing countries. KMC use in the U.S. has additional infant benefits of decreased pain sensation and cortisol stress levels, improved weight gain, less nosocomial infections, and decreased NICU hospitalization days. Our preliminary data identified racial disparities in provider perceptions of KMC benefit and inconsistent provision of KMC for racially diverse and often uneducated mothers. As the PT is born sterile and immediately separated from the mother, the early process of human bacterial colonization dependent on maternal exposure and critical for the infant's colonization repertoire as well as gut and immune development is interrupted. Previously, studies have demonstrated that oral microbial flora is transmitted vertically from mother to infant in the full term infant. Therefore, practices that decrease maternal to infant exposure may preferentially create less favorable infant colonization patterns to resist infection. As such the specific aims of this application are to: 1) Determine provider and maternal perceptions related to Kangaroo Mother Care with questionnaires, to evaluate provider and maternal barriers and perceptions related to benefit and access of KMC in the NICU so as to provide the basis for development of provider education to create equity in provision of KMC. 2) Determine the bacterial colonization concordance between mother and infant pairs Using DNA-based polymerase-chain-reaction assays, saliva and skin microflora samples will be analyzed for mother-infant bacterial colonization similarity, with or without KMC, and the likelihood of maternal beneficial bacterial transfer of Bacteriodes fragilis recognized in prevention of gut inflammation and S. sanguinus, an early colonizer that modifies the oral environment to be less favorable for cariogenic strains of Streptoccus mutans colonization. These results will provide essential insight into provider barriers to eliminate disparities to KMC and assist in designing methods to address equitable care for culturally diverse PT infants. Moreover, the results will provide biological evidence related to bacterial host interactions that may be a mechanism of KMC's beneficial role. PUBLIC HEALTH RELEVANCE: This is a resubmission application entitled " Transmission of Maternal Indigenous Bacteria to the Newborn through Kangaroo Mother Care: A method to improve Preterm newborn health" in response to PAR-07-39. We aim to determine care provider barriers that lead to disparities in provision of Kangaroo Mother Care (KMC) among non-white infants and to identify if KMC facilitates maternal to infant transmission of indigenous bacteria as a biological mechanism of its observed benefits. KMC is a method, endorsed by the World Health Organization (WHO), where the mother holds her newborn skin-to-skin upright between the breasts to improve PT outcomes. The proposed research will provide essential insight into provider barriers to KMC to assist in designing methods to address equitable care for culturally diverse PT infants in the NICU and will also provide further biological evidence related to bacterial host interactions that may be a mechanism of KMC's beneficial role.